Comparative efficacy of low-density lipoprotein cholesterol (LDL-C)-lowering therapies in first-time vs. recurrent myocardial infarction prevention: a meta-analysis of large-scale randomized controlled trials
Authors' conclusion
Our findings suggest that LDL-C-lowering therapies may offer a greater benefit in preventing first-time MI compared with recurrent MI.
Study context
- Population
- Participants in large-scale randomized controlled trials (RCTs) of LDL-C-lowering therapies for prevention of first-time or recurrent myocardial infarction (MI)
- Participants
- 180,304 participants22 RCTs
- Comparison
- LDL-C-lowering therapies in first-time vs recurrent MI prevention
- First-time MI preventionn = 79,604
- Recurrent MI preventionn = 100,700
- Outcome
- MI risk (RR), first-time vs recurrent MI prevention
Methodological detailsrandom-effects model, RCTs with ≥1000 patient-years of follow-up
- Random-effects model
- RCTs with ≥1000 patient-years of follow-up
Pooled result
As reported in the abstract
MI risk with LDL-C-lowering therapies
LDL-C-lowering therapiesRelative risk (95% CI)P value
First-time MI prevention; 12 RCTs; 38% reduction
0.62(0.55–0.69)
P < 0.001Recurrent MI prevention; 11 RCTs; 16% reduction
0.84(0.80–0.88)
P < 0.001- Benefit magnitude differed significantly between first-time and recurrent MI prevention (Cochran's Q = 22.63)
- P < 0.001
Further pooled results
Robustness of findings
- Supported by leave-one-out analyses, no publication bias, high-quality GRADE evidence, subgroup and sensitivity analyses
Original publication
Comparative efficacy of LDL-C-lowering therapies in first-time vs. recurrent myocardial infarction prevention: a meta-analysis of large-scale randomized controlled trials. Eur J Prev Cardiol. Published 12 June 2025. doi:10.
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